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Prophylaxis of Rheumatic Fever/Rheumatic Heart Disease–Penicillin or Azithromycin, Who Wins?
For eradication of rheumatic fever (RF)/rheumatic heart disease (RHD), we must have a simplified diagnosis, and a treatment which is painless, easily available and safe; prophylaxis must be painless, safe, easily available, readily administered, and comprising a weekly oral single dose.
Arati's regime for management of RF/RHD (ARMOR) consists of diagnosis and management of RF/RHD in today's context in a very easy and simplified way.
ARMOR criteria: Arthritis or arthralgia with typical features suggestive of RF, carditis or cardiac involvement, typical of RF or RHD, and echocardiographic evidence of rheumatic heart valve involvement should essentially be the criteria to diagnose RF and RHD with high specificity and sensitivity.
With regard to treatment of RF/RHD, we need a drug which is highly efficacious against Group A Beta Hemolytic Streptococcus (GABHS), which is the causative agent for primary prevention and treatment and secondary prophylaxis.
The best drug discovered, to date, for GABHS is azithromycin.
ARMOR for primary prevention, treatment and secondary prophylaxis of RF/RHD is as follows:
Azithromycin must be given in a dose of 500 mg 1 tablet daily for 5 days, followed by 1 tablet once a week for 1 year.
Penicillin for treatment and prophylaxis must be given up due to its lack of availability, side effects, risk of anaphylaxis, parenteral preparation, hazards of administration, need for sensitivity test each time, etc. and replaced by azithromycin.
13 April 2021 (online)
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- 1 International rheumatic fever study group: allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever. Lancet 1991. 337. 1308-1310
- 2 Donde S, Mishra A, Kochhar P. Azithromycin in acute bacterial URTI: an Indian noninterventional study. Indian J Otolaryngol Head Neck Surg 2014; 66 (Suppl. 01) 225-230
- 3 Gerber MA, Baltimore RS, Eaton CB. et al. AHA Scientific Statement. Prevention of RF and diagnosis and treatment of acute streptococcal pharyngitis. Circulation 2009; 119 (11) 1541-1551
- 4 Thomson WO. Sudden death following injection penicillin. BMJ 1952; 2 (477) 70-72
- 5 Altamimi S, Khalil A, Khalaiwi KA, Milner R, Pusic MV, Al Othman MA. Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children. Cochrane Database Syst Rev 2009; (01) CD004872
- 6 Lalchandani A, Rana M, Mehrotra M, Prabhu K. Taruni Lalchandani: benzathine penicillin must be substituted with azithromycin for treatment and prophylaxis of RF. Circulation 2010; 122: e115 p712 https://doi.org/10.1161/CIRCULATIONAHA.110.192774
- 7 Marko SB. Benzathine Penicillin G for the Prevention of Rheumatic Fever and Rheumatic Heart Disease in the Deve-loping World: A Global Survey of the Quality and Quantity of Supply [master's theses]. CT, USA: UCONN Library, University of Connecticut Graduate School; 2014
- 8 Seckeler MD, Hoke TR, Gurka MJ, Barton LL. No demonstrable effect of benzathine penicillin on recurrence of rheumatic Fever in pacific island population. Pediatr Cardiol 2010; 31 (06) 849-852
- 9 AHA scientific statement. Circulation 2009 119. 1541-1551
- 10 Daniels ED, Mohanlal D, Pettifor JM. RF prophylaxis in SA. S Afr Med J 1994; 84: 477-481
- 11 Lalchandani A, Shameem M, Chandra S. et al. Use of alternative drugs for RF prophylaxis in place of injection benzathine penicillin. Indian Heart J 2005; 57: 462
- 12 Schaad UB. Acute streptococcal tonsillopharyngitis: a review of clinical efficacy and bacteriological eradication. J Int Med Res 2004; 32 (01) 1-13
- 13 Azithromycin (ARMOR) must replace benzathine penicillin for treatment and prophylaxes of rheumatic fever. Available at: https://www.longdom.org/conference-abstracts-files/2155-9880.C1.036-019.pdf. Accessed January 1, 2021